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Inflammatory Bowel Disease (Ibd):Very Young Patients Can Also Be Affected

15.07.2008

Inflammatory Bowel Disease or IBD – a condition that includes both Crohn’s Disease and Ulcerative Colitis – is no longer limited to the adult population.

A research carried out by the Pediatric Clinic of the University of Trieste (Italy) at the Institute for Maternal and Child Health Burlo Garofolo, a hospital highly specialized in infant health, reports an increased prevalence of IBD not only among the general pediatric population, but surprisingly, also in children younger than two years of age.

The study, launched in 1984 and completed along 20 years, was recently published by the European Journal of Pediatrics. It reached two main conclusions:

-very early onset IBDs (before the age of 2) represent an estimated 9% of all the pediatric onset IBDs (occurring before the age of 16)

-these early forms are particularly severe versions of the disease and may hide an underlying inborn error of the immune system, therefore they require a more invasive therapy other than surgical and immunosuppressive therapies.

Moreover, since the disorder may initially be mistaken as a food allergy, the diagnosis is often delayed.

The Pediatric Clinic of the IRCCS Burlo Garofolo followed 184 patients affected by IBD for a minimum of two years. 8.6% of these (16 children) were diagnosed with IBD within their second year of life (as many as 12 children were diagnosed before the first year). In 12 out of 16 cases the IBD diagnosis was confirmed by additional investigations, while in the remaining 4 cases other conditions involving the immune system were identified.

As many as half of the patients were initially classified as allergic to cow’s milk proteins. For this reason they underwent an exclusion diet for a long time, despite the absence of any clinical benefit. Overall, these cases turned out being more severe if compared to the ones with a later onset and often surgical and aggressive immunosuppressive treatment were required.

“Being in the privileged position of reference centre that followed more than 300 IBD pediatric cases in the last two decades – underlines Alessandro Ventura, director of the Pediatric Clinic of the University of Trieste at the IMCHBG – we realized that IBD can have a very precocious onset: if this is the case, the disease tends to be particularly severe. In the past, IBD was long considered specific of the adult population, therefore pediatricians rarely looked for it within the pediatric groups.

Even today IBD symptoms are often misclassified as cow’s milk protein allergy, which causes a severe diagnostic delay. For this reason, the presence of an inflammatory intestinal disorder should be kept in mind by the pediatricians: if an intestinal problem, such as bloody-mucous diarrhoea, persists after 3-4 weeks, especially if in the presence of fever, impaired growth, weight loss, perianal fistulas or abscesses, one should include IBD in the differential diagnosis.”

“We estimate that in our region, Friuli Venezia Giulia, some 50 children suffer from the disease” explains Stefano Martelossi, Director of the Department of Gastroenterology at IMCHBG. “At present, our center is following 50 patients from FVG affected by this disorder and more than 200 from other Italian regions. This study proved that IBDs can show up at any age, including the very first years of life. Therefore, it is mandatory that pediatricians be well aware and alerted to promptly recognize the disease. The earlier the onset the more severe the disease, and the more negative the consequences of a diagnostic delay. One should also keep in mind that, in some cases, a very precocious onset might hide and underlying inborn error of immunity.”

MORE INFORMATION ON IBDIBD is a family of chronic invalidating disorders characterized by inflammation of the intestinal mucosa, diarrhoea, maladsorption, blood in the stools and other complications. While the genetic predisposition to the disorder has been demonstrated, several hypotheses based on an alteration of intestinal immunity have been proposed to explain the recent increase in the disease prevalence among both adult and pediatric population.

Currently, no definite therapy exists for IBD. However, recently, several so-called biological drugs made by monoclonal antibodies, tailor-made to inactivate specific targets such as the molecules that trigger inflammation, were used to treat IBD. A prompt use of these medications allows a better control of the symptoms and offers the patients an acceptable quality of life.

Reference:

"IBD and IBD mimicking enterocolitis in children younger than 2 years of age"

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